NYC 9/11 Public Portal Document
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NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
' Asbestos Control Program
59-17 Junction Boulevard, 8°iFloor, Corona, NY 11368.5107
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ONL1 ASBESTOS. PROJECT NOTIFICATION W
(ASBESTOS INSPECTION REPORT) i _U
tee schedule)
When submitting this form at the NYC Department of Buildings, the original form and three (3) copies with original '
signatures are required. Submittal at the NYCDEP requires one copy of the form with original signatures. This
form must be submitted to the NYC DEP not less than one week In advance of the start of abatement activities.
I. FACILITY
2. Address 5 l M. U &A ( 9'T Borough zip 400
AKA - 3. Block _ 4. Lot
5. Type of Facility 6. Name of Building
It. BUILDING OWNER
7. Name __6 1 a i i T E-h CO iU 8. Contact Person _ fG.YYt Qk La
9. Tel. #( R In
lD ~- Fax# 01.1) 607— L/((&,
10. Address City NJ 7 State __ _ 2fp o7.....
III. GENERAL CONTRACTOR /
11. Name Tel. #
IV. ASBESTOS ABATEMENT CONTRACTOR
12. Name _J / E'e G ) .6 !t 13. Contact Person ~~7~ (::::3/,9
14. Federal Employer ID. # PH j 15. Tel. # ~1 G - 7~I~`300 0 Fax #_____________
1) 16. Address _~~ ~ S ~ City J f! State N Zip _117
V. THIRD PARTY MONITOR
At
17. Name bk A~ J *M ZE Q.. t ~S, f C 18. Contact Person Ytt L 4.
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19. Federal Employer ID. # 20. Tel.# ara-gas-Goj Fax#2t3 992-06 O
21. Address . g 1Kt i1tç S (✓ E ( City ,_t ' 3 w- tC
T— State ~ Zip 00 (
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22. Sample Analysis Laboratory C(~c l (Ft'L h> Z (~`K'f£Sr ~
ct 23. NYS DOH EtAP # _(f s -C .
VI. PROJECT INFORMATION
24_Starting date for this portion of work (4/21/02 Projected completion date 7 l5 C2—
Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday 0 Friday ❑•Saturday ❑ Sunday
Shift from: ❑ am 0 pm to 0 am 0 pm
If other,
specify pr,4 CP
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Access to Inspect the premises must be provided during the work schedule Indicated In this Item. M `u N 1 8 i o
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25. Total amount of asbestos-containing material to be abated during this work =3rESTOS/LEA_
CA
/41/ L D Square Feet. and/or Unear Feet P TRUGM
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NYC-WTC 000100304
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